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The ‘serious’ factor in germline modification
  1. Erika Kleiderman1,
  2. Vardit Ravitsky2,
  3. Bartha Maria Knoppers3
  1. 1 Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
  2. 2 Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
  3. 3 Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
  1. Correspondence to Erika Kleiderman, Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; erika.kleiderman{at}


Current advances in assisted reproductive technologies aim to promote the health and well-being of future children. They offer the possibility to select embryos with the greatest potential of being born healthy (eg, preimplantation genetic testing) and may someday correct faulty genes responsible for heritable diseases in the embryo (eg, human germline genome modification (HGGM)). Most laws and policy statements surrounding HGGM refer to the notion of ‘serious’ as a core criterion in determining what genetic diseases should be targeted by these technologies. Yet, this notion remains vague and poorly defined, rendering its application challenging and decision making subjective and arbitrary. By way of background, we begin by briefly presenting two conceptual approaches to ‘health’ and ‘disease’: objectivism (ie, based on biological facts) and constructivism (ie, based on human values). The basic challenge under both is sorting out whether and to what extent social and environmental factors have a role in helping to define what qualifies as a ‘serious’ disease beyond the medical criteria. We then focus on how a human rights framework (eg, right to science and right to the highest attainable health) could integrate the concepts of objectivism and constructivism so as to provide guidance for a more actionable consideration of ‘serious’. Ultimately, it could be argued that a human rights framework, by way of its legally binding nature and its globally accepted norms and values, provides a more universal foundation for discussions of the ethical, legal and social implications of emerging or disruptive technologies.

  • concept of health
  • ethics
  • gene therapy/transfer
  • genethics
  • genetic engineering

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  • Contributors All authors were involved in the conception and design of this manuscript. EK carried out the research needed and drafted the first version of the manuscript. VR and BMK provided critical revision and edits to several versions of the manuscript. All authors read and approved the final version of the manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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